FEEBLE-MINDEDNESS
SOCIAL HYGIENE. March 1915. Vol. 1, No 2. Recent Progress in Social Hygiene in Europe. James B. Reynolds, Counsel, The American Social Hygiene Association.
Recent studies of prostitutes there (in Europe) as here have strikingly brought to light the significant relationship between prostitution and mental defectiveness. A far reaching contribution to the solution of the problems of sex education and prostitution was the Mental Deficiency Act of 1913 for England and Wales. This Act was based on the Report of a Royal Commission on the Care and Control of the Feeble-minded which made a careful and exhaustive study of the entire subject, including the methods of treatment of the mentally defective in all countries. The Commission declares that a great proportion of the evidence unmistakably indicates that mentally defective children are greatly lacking in self-control and peculiarly open to suggestion and hence specially susceptible to the influence of depraving companions. The testimony of numerous experts who appeared before the Commission is highly illuminating on these points. Dr. Kerr, medical officer of the London County Council, declared that sooner or later many of these children will be found in the hands of the police, or in maternity hospitals. Dr. Ashby, late medical officer of the Manchester Special Schools stated that the mental defectives tend to an increase of the criminal and immoral classes. Dr. Whittell, Medical Superintendent of the Suffolk County Asylum, argued that the natural and physical evolution of this class is apt to result in various offenses of sexual, or perverted sexual, nature. Dr. Corner, Lecturer on Mental Diseases in the North East London Post Graduate Hospital, said, “One of the most common and dangerous characteristics of the feeble-minded is that they tend to sink socially.” Another expert testified that mentally defective girls in large cities are subject to overwhelming temptations and pressure toward sexual immorality, while still another, looking to the larger aspects of the problem, called attention to the danger resulting from the immoral laxness of mentally defective girls, and the lowering of the mental stamina of the whole nation by the increase of a population of defective intellect. Sir Francis Galton went so far as to declare that mentally defective women commonly become prostitutes. The feeble-minded, as distinguished from idiots, are an exceptionally fecund class, mostly of illegitimate children, and a terrible proportion of their offspring are born mentally deficient. All these experts were in agreement that mentally defective girls are in great danger of becoming immoral, hence prostitutes.
DEGENERACY, ITS CAUSES, SIGNS AND RESULTS. Eugene S. Talbot, M.D. Walter Scott, Ltd., London; Chas. Scribner’s Sons, N. Y. 1898.
Pauline Tarnowsky in her study “Etudes Anthropometriques sur les Prostituées” finds that in Russia prostitution is crime in women taking the line of least resistance. She concludes from her researches, which mine tend to verify, that the prostitute as a rule is a degenerate being, the subject of an arrest of development, tainted with a morbid heredity, and presenting stigmata of physical and mental degeneracy fully in consonance with her imperfect evolution. C. Andronico of Messina, Italy, arrived some time previously at the same conclusions as those of Tarnowsky.
FEEBLE-MINDEDNESS, ITS CAUSES AND CONSEQUENCES. Henry Herbert Goddard, Director of the Research Laboratory of the Training School at Vineland, N. J., for Feeble-minded Boys and Girls. McMillan Co., 1914.
Among the different causes for the social evil feeble-mindedness has been suggested, but nowhere has it been given the prominence that is due it. Anyone who understands feeble-mindedness, especially the moron, cannot expect anything less than that great numbers of these girls will fall into the life of prostitution. As to the actual statistics on this subject we have almost none. One very significant record comes from Geneva, Illinois, made by Dr. Bridgman. She found that of 104 girls in the Reformatory who were committed for an immoral life 97% were feeble-minded. This does not by any means indicate that 97% of prostitutes are feeble-minded, because it is only natural to expect that the feeble-minded ones would be the ones to be caught and sent to an institution. These figures, nevertheless, give us some idea of the prevalence of feeble-mindedness in this traffic. Many competent judges estimate that 50% of prostitutes are feeble-minded. Pages 14–15.
The 327 cases here presented constitute a unitary group. They have not been selected. They are of all ages and grades of defect. Page 7.
Our 327 families naturally fall into six fundamental groups, as follows: 4—Accident Group, 57; 5—No Cause, 8; 6—Unclassifiable, 27. Pages 47–48.
The following table gives an idea of the fecundity of these groups of women.
| No. of Mothers | No. of Children | Average | |
|---|---|---|---|
| Hereditary | 139 | 992 | 7.1 |
| Probably Hereditary | 27 | 168 | 6.2 |
| Neuropathic | 36 | 204 | 5.6 |
| Accident | 50 | 258 | 5.1 |
| No Cause | 8 | 258 | 5.7 |
| Unclassified | 27 | 118 | 4.3 |
| ——— | ————— | ——— | |
| 287 | 1,786 | 6.2 |
In addition to the mentality, whether normal or feeble-minded, record has been kept of certain diseases and conditions supposed to be more or less associated with feeble-mindedness in a causal relation. These are the following: 1—Alcohol; 2—Tuberculosis; 3—Sexual Immorality; 4—Paralysis, Insanity, Epilepsy, Neurotic Condition, Syphilis, Criminality, Deafness, Blindness, Migraine, Goitre, Vagrancy. Page 473.
Sexual immorality is closely associated with hereditary feeble-mindedness. Closely connected with the subject of sexual immorality is the one of illegitimacy. Our records show 278 illegitimate children of whom 259, or 93% are in the pure Hereditary group, 12 in the Probably Hereditary group, 3 in the Neuropathic, and 4 in the Accident group. There is nothing new in these facts. They are simply confirmatory of what we have found in other lines. Page 499.
The feeble-minded person is not desirable; he is a social encumbrance, even a burden to himself. In short, it were better, both for him and for Society had he never been born. Should we not then in our attempt to improve the race begin by preventing the birth of more feeble-minded? Page 558.
THE FEEBLE-MINDED A SOCIAL DANGER. A. F. Tredgold, L.R.C.P., London. M.R.C.S., England. Medical Expert to the Royal Commission on the Feeble-minded, etc. Eugenics Review. Vol. 1, April, 1909. Pub. Eugenics Education Society, London.
In England and Wales on January 1st, 1906 there were a total of 138,529 persons in the country who were defective in mind. This corresponds to 4.03 per thousand population, or to one mentally defective person in every 248. In England and Wales on January 1st, 1906, there were no less than 125,827 insane persons. If we add these to the number of the mentally deficient which I have just stated, we find that in this country there is one person out of every 130 who suffers from severe disease of the mind. P. 98–99.
According to the Registrar General, the average number of births to a marriage in the whole population of this country is 4.6. I have ascertained that the average number of births in these degenerate families is no less than 7.3. It is obvious that if this alarming propagation is not checked, the time must inevitably come when our nation will contain a preponderance of citizens lacking in that intellectual and physical vigor which is absolutely essential to progress. P. 98.
RASSENVERBESSERUNG. Translated from the Dutch of Dr. J. Rutgers. Second Edition, Dresden, 1911.
A not insignificant factor in the use of houses of prostitution is furnished by married men who in the “old fashioned” way wish to “protect” their wives, in order not to be burdened with too many children. Neo-Malthusianism is also the best weapon against this class of supporters of prostitution. P. 73.
MASSACHUSETTS COMMISSION FOR INVESTIGATION OF THE WHITE SLAVE TRAFFIC.
This investigation under Dr. Walter Fernald, included a physical examination study of family and personal history, social reactions, and standards, etc. Out of the 300 prostitutes 154 were feeble-minded (all doubtful were called normal). The 154 were so pronounced as to warrant legal commitment. None of them had the mentality of a normal child of 12 years old. Majority were that of 10 or 9 years old.
INVESTIGATION OF VIRGINIA STATE BOARD OF CHARITIES.
This investigation presents a very high percentage of aments among the prostitute residents of the Richmond red light district. Of 120 persons tested the examiner found 42 or 35% imbeciles and 58 or 48.3% to be morons. That is 100 or 83.3% were mentally defective and only twenty or 16.7% were declared normal. Out of this number 93 were found to be between the ages of 20 to 30 and 16 between 30 to 40. All in the child-bearing age, as one will note. That 100 out of the 120 needed institutional care, that they should not reproduce their kind, was of course apparent.
THE MENTALITY OF THE CRIMINAL WOMAN. A Comparative Study of the Criminal Woman, the Working Girl and the Efficient Working Woman in a Series of Mental and Physical Tests. Jean Weidensall, formerly Director of the Department of Psychology, Laboratory of Social Hygiene, Bedford Hills, N. Y. Warnick and York Inc. 1916.
Tests applied to a group of children of working age by the Bureau of Educational Guidance of Cincinnati were also used on a group of 20 maids at Vassar as a norm for testing the women committed to Bedford. 100 reformatory subjects were used for the tests. It is a matter for question whether loss of the parent is the cause of the child’s leaving school and going to work early and of the ultimate unsocial conduct in the case of the Bedford group, or whether loss of parent, retardation, misconduct, etc., are not for the most part but manifestations of the same thing—irresponsibility, mental, physical and social inferiority on the part of both parents and child. The facts at our disposal and eugenic investigations lead us to believe that the latter is in the larger measure true. Out of 100 women recorded 30 had had from one to five illegitimate children. Of the 100 tests for syphilis and gonorrhoea, 45% positive, 4% doubtful, 51% negative, for syphilis. 60% positive, 22% doubtful, 18% negative for gonorrhoea. At best strong character cannot be the rule among individuals ⅔ of whom have less intelligence than that possessed by the average individual among a group of children of 15, (of whom half are themselves retarded), and almost surely not when they have been too untrained industrially and too unschooled socially to have acquired simple every-day habits of restraint and inhibition. Even the more intelligent third of the reformatory subjects differed very obviously and unmistakably in stability and emotional control from the group of Vassar maids.
THE MENACE OF MENTAL DEFICIENCY FROM THE STANDPOINT OF HEREDITY.[[51]] By Henry H. Goddard, Ph.D., Vineland, N. J. New Jersey Training School.
[51]. Read before the conference of the Massachusetts Society for Mental Hygiene, Boston, November 19, 1915.
From the standpoint of the child, something can be done to make them a little happier; from the standpoint of society, no amount of mental hygiene can ever render them efficient citizens. Society can, by proper treatment, render them less of a menace than they are naturally, and the ills that we now suffer on account of them can be largely reduced.
It is estimated that there are from 300,000 to 400,000 mental defectives in the United States. That is based upon the United States census of 1890, in which the question was asked “Whether defective in mind, sight, hearing or speech, or whether crippled, maimed or deformed, with name of defect.” Now if anyone can estimate what proportion of the true number of the feeble-minded would be returned in answer to that question, he will be able to estimate how near the truth is the 200,000 which the census report gives. Three hundred thousand or 400,000 seems to be a conservative estimate.
I am to discuss this topic from the standpoint of heredity. It has not yet been successfully contradicted that two-thirds of this army of 300,000 or 400,000, owe their condition to heredity. A quarter of a million of these people are feeble-minded because their ancestors were feeble-minded. They have inherited the condition just as you have inherited the color of your eyes, the color of your hair, and the shape of your head. There is a tendency in these days to attribute a great deal to heredity. But of this particular thing there seems to be no question. The menace of the problem comes, not from the fact that a quarter of a million inherited their condition, but because they are transmitting that condition to their offspring. Of that quarter of a million feeble-minded persons in the United States, do you know how many are being cared for, guarded and kept from propagating their kind? About 24,000 out of 250,000 are to-day being cared for in such institutions as you have here at Waverley. The rest are living their lives, are raising families, and providing abundant opportunity for the exercise of the charitable impulses of numberless generations to come. And that condition of things is getting worse rather than better.
What shall we do? There have been two answers. Some say, “Segregate, shut them up. Keep the sexes apart.” We are told that if we could do this for a generation our problem would be largely solved. The two-thirds in which the condition is largely hereditary would be eliminated. I want to assure you that the problem is larger than that. In the first place, looked at from the practical standpoint, we do not seem to be able to segregate. We are taking care of 24,000, and there are at least 250,000 to be cared for. If the State of New York cared for its estimated proportion of mental defectives, it would require thirty institutions of 1,000 each. They find it hard to raise money for the three or four institutions they now have. Their appropriations are cut every year. In the State of Massachusetts there are at least 14,000 feeble-minded persons. It would require ten institutions the size of Waverley,—a demand upon the public treasury which we are not willing to meet. I have not found anyone yet who is optimistic enough to think that we shall meet the demand within any reasonable length of time,—a time so short that we can safely rely upon that as a solution of the problem.
I have said that this quarter of a million, this army of feeble-minded people, are propagating. They are propagating a progeny of feeble-minded at somewhere from two to six times as fast as the intelligent people are propagating their kind. That is another serious part of the problem. I should like to digress from my particular field for a moment to make a suggestion on the other side. It makes one feel pessimistic when we find that the good stock here in New England—the stock than which there is no better in the world—is gradually disappearing for lack of issue. Of one family after another one reads all too frequently, “The last of his family has passed away.” We are told sometimes that two children in a family are all that can be properly reared; that it is better to rear two children and rear them properly than to rear a larger family and rear them badly. If two children in a family are all that our best and finest and nobler families can properly raise, how many children ought to be raised in a family of these low-grade people? The average in the United States is, for all classes, something less than two, and the average for these defectives is from four to twelve. In that little family that we ran across down in New Jersey, which we call the Kallikaks, you will recall that the good side started from six ancestors. That is to say, Old Martin Kallikak, after he married, had seven children, one of whom died without marrying. From the six who lived and married, sprang all the normal descendants. Martin’s illegitimate son, the child of the feeble-minded girl, was the only one on the bad side, and yet to-day the number of descendants from the illegitimate mating is practically the same as the number descended from the six legitimate children. You can see that it does not take many generations for the progeny of the unrestrained feeble-minded to equal and even outstrip the normal. Our good stock is multiplying very slowly. Our poor stock—the lowest strata of society—multiplies in what might really be called a brutal ratio. If civilization is to advance, our best people must replenish the earth. I think it should be a part of our religion to replenish the world with good, clean people.
We need to know vastly more than we know to-day before we can give definite answers, except in the case of marriage between two feeble-minded persons. Now, that being the case, the argument that I want to make to you is: the propagation of the feeble-minded is going on at an enormous rate. If we could do, and if we did, everything that we wanted to do, and that we knew enough to do, we should be getting only at the surface of the problem, and should be sure in only about one case out of the six possibilities. Now if that is the case, my friends, does it seem that we ought to put off attacking the problem until we cannot stand it any longer? Or does it mean that we had better attack it right away? Is it not best to begin hunting for these defective children wherever they may be found? And they can be found in the school, in our juvenile courts, in our almshouses, in our insane hospitals, in our reform schools, in our homes for cripples, in our asylums for the blind,—in short, wherever there is a dependent group there is an undue proportion of these mental defectives.
Some will say, “If they are in almshouses they are being cared for.” In reality they are being raised and brought to manhood and womanhood and then sent out, to propagate their kind. Fifty years ago the problem was not as serious as it is to-day, because these defectives were out in the world by themselves, getting killed by a runaway horse, or falling into machinery, or in some way meeting an untimely death. To-day we are exceedingly careful; we are protecting them in every possible way; we are taking care of them in our institutions and giving them every advantage, and then sending them out into the world—a menace to the rest of humanity.
It would be a dreadful thing if all these problems were solved and we didn’t have any people to give our money and charity to. I suppose we should become hard-hearted if we didn’t have any to befriend. Perhaps we want to keep enough of these unfortunates so that we can still contribute to their safety and welfare. But, my friends, when we realize the suffering, the terrors, the losses of all kinds that these people unintentionally, unwittingly cause us, we have another side of the problem. The menace of the feeble-minded is not a figure of speech. It is no undue sentimentalism that assures us that we need to take care of this group of people. We need to study them very seriously and very thoroughly; we need to hunt them out in every possible place and take care of them, and see to it that they do not propagate and make the problem worse, and that those who are alive to-day do not entail loss of life and property and moral contagion in the community by the things that they do because they are weak-minded.
HEALTH FIRST AND MATRIMONY AFTERWARD. By Edward C. Spitzka, M.D. The Semi-Monthly Magazine Section of the Boston Globe, the Washington Post, the Philadelphia North-American, the Pittsburgh Dispatch, the Chicago Tribune, the St. Louis Globe-Democrat, the Cincinnati Enquirer, etc. May 11, 1913.
We cannot tell men and women how they should mate in order to insure positive types of offspring. But we can state, emphatically, and without reserve, that persons suffering from certain diseases should not enter into the marriage relationship, at peril of the health and happiness of children that may be born to them and the well being of the community at large.
I believe that municipal and state governments should take cognizance of this fact. Eventually it will be regarded as a matter for Federal, perhaps for international action. Every candidate, man or woman, applying for a marriage license should be required to present a physician’s certificate declaring him or her to be free from insanity and certain virulent transmissible diseases.
What then are these diseases? I will list them in the order of importance as menaces to humanity.
1. Constitutional insanity.
2. The two great forms of constitutional venereal disease: syphilis and gonorrhoea—the former as a source of danger to both the marriage partner and offspring, the latter to the marriage partner only.
3. Deformities that are likely to be associated with the transmission of serious defects of the nervous system, such as cleft palate, hermaphroditism, etc.
4. Epilepsy of the standing of more than one generation.
Medical statistics prove that a proportion of three out of every five children born to imbecile parents are certain to be weak-minded, and that the marriage of such unfortunates is a calamity to the race. Syphilis persists from generation to generation. Any sufferer from this disease who marries before he is certain that it has been eradicated from his system is guilty of a crime against society.
I have hesitated about including epilepsy in this list. It is undoubtedly transmissible to the offspring, though transmission does not occur in every case. A conservative ruling would be that an epileptic who is believed to be the first of his line to contract the disease should be permitted to marry, in the event of his being declared cured. But the epileptic sons and daughters of epileptic parents should, under no circumstances, be licensed to marry.
Note: The late Dr. Spitzka, along with other authorities quoted as being opposed to the marriage of the unfit, was concerned with the diseased offspring which almost invariably result from such marriages. Except in the case of gonorrhoea, which can be transmitted to the marriage partner, he did not object to the union itself, provided the latter remained childless. He would have recommended the use of contraceptives, as the solution of the problem, had he not been prohibited by the law from doing so.
HEREDITARY SYPHILIS IN THE LIGHT OF RECENT CLINICAL STUDIES. Pamphlet. Borden S. Veeder, M.D., St. Louis, Mo. From the American Journal of the Medical Sciences, October, 1916. No. 4, Vol. CXII. P. 522.
In the present state of our knowledge we can summarize the evidence as pointing to the view that in hereditary syphilis the mother is always infected, although very frequently the infection is latent and that true germinal infection does not occur.
Syphilis as a Social Problem. No accurate figures are available as to the incidence of hereditary syphilis. The disease is not reportable, and even if it were it is doubtful if the records obtained in this way would be of any value, as the condition is frequently overlooked, and when recognized would be concealed in many cases because of the stigmata attached. With improved methods of diagnosis we are beginning to learn that it is far more common than previously thought, as many conditions in which the etiology was obscure have been found to be the result of a syphilitic infection. Hospital statistics are of little value in this connection. In St. Louis we have been particularly interested in hereditary syphilis, and have admitted many cases to the Children’s Hospital for study which would normally have been cared for in the out-patient clinic, and hence the proportion of syphilis to the total number of admissions is relatively high. We have seen between 300 and 350 children with an hereditary infection in three and a half years and have undoubtedly failed to recognize a number of cases. We have also found many cases of latent syphilis by testing the apparently healthy children of syphilitic families. What is more important is the number of obscure clinical conditions which have been found to be syphilitic in origin.
The importance and cost of syphilis to the family and the community is not generally appreciated. About this point we have collected some interesting information: For a period of about a year an attempt was made to obtain extensive data in regard to the family of every syphilitic child coming to the clinic, to examine all of the other living children as well as the parents, and to test the blood of each member by the complement-deviation method. In this way data was assembled for 100 syphilitic families. Many marriages (10 to 30 per cent.) remain sterile as a result of syphilis and others (13 per cent. according to Haskell) result only in abortions. Our material includes only those families in which a living child came under our direct observation and care.
In these 100 syphilitic families 331 pregnancies occurred which resulted as follows:
| Abortions | 100 or 30.2 per cent. |
| Stillbirths | 31 or 9.3 per cent. |
| Living births | 200 or 60.5 per cent. |
Thus 40 per cent. of the pregnancies terminated in the death of the fetus before term. If the parents had been healthy and of the same social strata we might have expected 30 to 35 deaths before term, or a mortality of 10 per cent. instead of 40 per cent.
Considering next the 200 living births: At the time the data were collected 39 were dead and 161 alive, but 12 of the 161 died during the course of the investigation. Of the 161 examined 107 had both clinical signs of syphilis and a positive Wassermann; 5 were clinically positive but gave negative tests (in all of these the family gave a history of syphilis); 16, although negative as regards clinical manifestations, gave positive reactions, and therefore belong to the group of latent syphilitics. Thus but 33 of the 161 living children were free from the infection, and if we attribute the deaths occurring before term to syphilis, we find that of the 331 pregnancies in 100 syphilitic families but 10 per cent. escaped the infection. The toll is summarized in the following table:
| 331 PREGNANCIES IN 100 SYPHILITIC FAMILIES | ||||
|---|---|---|---|---|
| 131 | or 40 per cent. | died before term | } | |
| 51 | or 15 per cent. | died after birth | } | 55 per cent. dead |
| 116 | or 35 per cent. | living but syphilitic | 35 per cent. syphilitic | |
| 33 | or 10 per cent. | living and free from syphilis | 10 per cent. escaped | |
| ——— | ||||
| 331 | ||||
If we add to this record and take into consideration the physical condition of the parents—both of whom were syphilitic in almost all of our cases—we begin to grasp the appalling importance of syphilis from a social standpoint.
In order to show this in another way, studies[[52]] were made in our clinic in which the waste (total deaths to total pregnancies) occurring in 100 families in which we were treating children with contagious disease, and in 100 families selected at random from our records, were contrasted with the waste in 100 syphilitic families. These groups are designated as C. R. and S. respectively and the data briefly summarized in the following table:
[52]. Jeans and Butler, Hereditary Syphilis as a Social Problem, Am. Jour. Dis. Child., 1914, viii, 327.
| Group | Total pregnancies | Deaths before birth | Born living now dead | Total | Per cent. waste |
|---|---|---|---|---|---|
| C. | 444 | 46 | 70 | 116 | 26 |
| R. | 442 | 42 | 59 | 101 | 22 |
| S. | 453 | 116 | 104 | 220 | 48 |
The increase in the waste for the syphilitic group of 100 per cent. does not represent the total waste, as it is fair to assume that three-quarters of the living children are syphilitic and many of these defective.
Syphilis. None of the causes supposed to be potent causes of feeble-mindedness is so difficult of investigation, so enigmatical as Syphilis. Not only in the popular mind but in the professional thought, it is given a prominent place, yet of all the causes there is perhaps none for which there is less evidence. This does not necessarily mean it is not a cause, but simply that it is not proved. The terrible nature of the disease, the serious results that it is known to produce, such as miscarriage, deaths in infancy, general paralysis of the insane, the fact that it is one of the two diseases that can be transmitted from the mother to the child because the germs can pass through the chorion cells, the fact of its close connection with sexual immorality, all tend to render it in the minds of most people a horror of which anything can be believed. It is well understood by the medical profession that a mating which shows, first a number of miscarriages followed by deaths in infancy, and finally live offspring, is a picture that means syphilis in one or both of the parents almost without question. In conclusion, there is abundant evidence that syphilis produces miscarriages and early death.
It is claimed that syphilis is responsible for 42 per cent. of abortions and miscarriages, the remaining 58 per cent. embracing all cases of whatever character, artificial or otherwise.